November 2012 Newsletter


November 2012

Clinical Café Newsletter

By: Ronda Polansky M.S. CCC-SLP

Happy Thanksgiving!

There is no better time to express our appreciation for your business and friendship! The friendship of those we serve is the foundation of our success serving the DFW area!


This is the season to reflect on your blessings and those things for which you feel most thankful.  I know at DiagnosTEX, we are incredibly thankful for each and every one of you who use us as your preferred mobile MBSS provider and have shared your friendship and support over the years. We wish you and your families and very Happy Thanksgiving with many, many blessings this holiday season!

DON’T FORGET TO VOTE!!!!! This is a VERY important election for the future of healthcare!


DiagnosTEX November Holiday Schedule        Swallow and be thankful!

DiagnosTEX will be closed on Thursday, Thanksgiving Day, November 22nd and Friday the 23rd, to count our blessings and spend time with our families. We want to meet all of your MBSS needs because we know PO feeding becomes important on many levels to many of your patients around the holidays, especially when Thanksgiving is traditionally planned and prepared with a great deal of attention to food.  We also want to be fair and accommodating to each DiagnosTEX employee and their families. We are so thankful for them as well!  Please keep our holiday schedules in mind when scheduling your MBSS at the end of November (and December)!  ******Please take note and keep in mind that during this busy time of year, specific requests for specific times and/or days become exponentially difficult to accommodate.  We may be unable to quickly schedule your patient with certain time and day requests. Please notify your staff, patients, and families of this. ****** DiagnosTEX bases our mobile clinic schedules by geographical areas for time, efficiency and cost. If your patient’s schedule is limited to certain days and times, we recommend an outpatient facility (such as a hospital).  Our mobile service offers convenience in the equipment coming to you, not for the flexibility of specific days and time schedules.  Mobile offices also require flexibility in time; we are subject to many factors that can dramatically change our travel during the day and subsequently alter the exact time we may arrive.  We make a heartfelt effort to arrive during our scheduled time, but there are often things that are out of our control that may change our arrival time.  We will always call to keep you updated on our ETA.


ASAP studies – We had several “ASAP” requests on our pending list in many areas throughout DFW recently.  Of course everyone feels their study is just as important as the other one – and it is – but DiagnosTEX is unable to meet all ASAP requests at the rate most would prefer (especially when we are so busy).  We would recommend if the patient is in that critical of status, then the patient may need to be transferred to the hospital. If they are being discharged, we can always go to the home to complete a follow up MBSS, or they can come to us on an outpatient basis. Please let your patients and families know these options.


The 2013 DiagnosTEX Dysphagia Calendar will be available next month! 

Can you believe 2013 is that close??!!!

Speech Pathologists’ Association Near Dallas (SPAND) has invited me to present during their November meeting inRichardson on Tuesday, November 6 from 6pm to 8pm. The topic of the presentation will be the limitations of a bedside evaluation (BSE). 
Please go to or email all inquiries to  
Cost for nonmembers is $15.00 for this meeting and will count for 2.0 TSHA CEUs.


Upcoming ASHA Conference – November 14-17 in Atlanta, GA


DiagnosTEX Quality Assurance (QA) for 2012Each year we take at least 1 month and follow up on every patient we evaluate. QA was completed in order to assist DiagnosTEX to establish, maintain, and ultimately improve the provision of mobile MBSS. MBSS outcome measures are purposed to document compliance and efficacy of the recommended means of nutrition, diet, and/or liquid, and of determining effectiveness of corresponding recommendations regarding management and/or treatment. Follow-up on QA also assists in determination whether or not the recommendations outlined by the MBSS were followed, and if not, the reasons for noncompliance. The following areas are addressed within this QA report:

MBSS tallies per month vs. separate QA documentation, MBSS diet and treatment recommendations, analysis of patient outcomes post-MBSS, silent aspiration, removal of tube feeding/NPO status, use of strategies, esophageal disorders screened, and E-stim treatment. We appreciate your support and help with this as we contact you to follow up on your patients. This is not only helpful to DiagnosTEX but also to our profession and dysphagia evaluation because this information has been (and will be) shared at a national level.  We took data in October and will be following up in November with you on the patients we saw in October.  Thank you in advance for your help with this!


Favorite iPad apps for laryngectomy patients to utilize before and after surgeries ranging from no cost to only a few dollars:

  • Talk Tablet – app allows users to create electronic keyboard containing categories they will use daily
  • NeoPaul – appearance of real iPhone texting screen – converting text to speech
  • Verbally – Text-to-speech app using commonly used words on same page as keyboard
  • EZ SpeechPRO – separate male and female voice options, text heavy app with categorization by topic. Transforming text to speech
  • iComm – designed for children, but can be adapted for any adult.


Exceeding Therapy Cap – Congress will likely extend this cap again this year and the manual medical review.  CMS has posted a giant list of national provider identifier (NPI) numbers that correspond with start dates. Outpatient therapy providers not listed in the database will presumably face a manual medical review on Dec 1. There is still an $1800 cap shared between PT and ST. To exceed it, providers attach the KX modifier. Then there is a $3700 threshold for PT and ST combined and exceeding them requires jumping through a new hoop of manual medical review. Rehab providers must ask Medicare administrative contractors (MAC) for a “green light” at least 10 days before providing services. If MAC does not approve the exception to the therapy, they will explain why.  One thing to keep in mind: if a MD order is stamped rather than signed, the MAC will deny the request. 

Other quick facts and tips that every provider should know:

  • Therapy caps are applied to fee-for-service, Medicare Part B (outpatient) services, and do not include critical access hospitals, Part A (inpatient) therapy, or privately contracted Medicare plans (i.e., Medicare Advantage).
  • Therapy services performed in private practice, Part B skilled nursing facilities, home health agencies (only as Part B clinics), outpatient rehabilitation facilities (ORFs), rehabilitation agencies, comprehensive outpatient rehabilitation facilities (CORFs), and hospital outpatient departments are included in the total amount.
  • Services performed in hospital outpatient departments will not be available in the patient eligibility file until October 1, 2012, but will include all services performed beginning January 1, 2012.
  • Only those services provided in hospital outpatient settings on or after October 1st are subject to the requirements for the exceptions process for services exceeding $1880 and the new manual medical review pre-approval process for services above $3700 beginning October 1st.
  • Therapy caps include dollars paid by Medicare Part B, co-payments, and co-insurance, and can be accessed through the Medicare Administrative Contractors (MAC) patient eligibility files. ASHA has created a MAC Resource for therapy providers with the necessary links.
  • Hospital providers should not check the beneficiary’s therapy dollar amount until October 1st. The total dollar amount will not be updated to include hospital outpatient therapy claims until that date. Providers can however, begin preparation for the manual medical review pre-approval process 15 days prior to their application date (Phase 1, Phase 2, or Phase 3).

Medicare changes in 2013 – Auditors do not have “inside scoop” on patients; they do not have opportunity to hear verbal reports or talk to clinicians and rely SOLELY on documentation.  We may be providing good care but we must provide excellent documentation for the services our patients need. Our documentation, (including the consult forms for DiagnosTEX) is part of the medical record and NEEDS TO BE COMPLETE or the MBSS could be denied! With incomplete paperwork, we will not schedule.  Documentation has always been important but the profession has been lax in this area; we cannot afford to do that anymore.

Home Health Denials – CMS outlines conditions for Medicare home health coverage. The patient must 1) be confined to the home (this is why DiagnosTEX will only attempt to schedule a HH patient 3x, if they decline our scheduling attempts) 2) under care of MD, 3) receiving skilled nursing care or therapy. Service provided in a HH setting must be reasonable and necessary. The most frequent denials occur because the medical record does not support that the patient experienced a change or exacerbation in condition or care, and/or does not clearly document on the patient’s experience, limitations, or decline in function. Medicare requires that therapy documentation include prior and current level of functioning.  Please include this information on the history forms when requesting 1st MBSS or repeat MBSS!

Believe it or not! – In this new health care era, the Office of the Inspector General (OIG) is making home visit calls to employees. Such visits are now the norm in healthcare industry. Make sure you ask for identification and clarify by looking the agency up in a phone book. It is prudent any staff member of a healthcare facility seek legal advice before engaging in any interview. The OIG will discourage it, but unless they produce a warrant, the government cannot make you do anything before contacting legal counsel.  Be sure to get the agent’s business card.


Readmissions – Soon Medicare will enforce a new policy demanding that hospitals with high readmissions for 3 conditions – heart attack, pneumonia, and heart failure, to be paid less than hospitals with fewer preventable readmissions.  With this in mind, repeat MBSS are being denied if the patient is not following current recommendations from MBSS and still requiring medical care and treatment for dysphagia.   This information needs to be clearly explained to the patient and family; it is a new healthcare era.


TCU – Swallowing Clinic: a Fort Worth option for patients going home

Miller Speech and Hearing Clinic offers clinical swallowing services as a practicum experience for students in the Department of Communication of Sciences and Disorders.  A sliding fee schedule is available upon request.  Please contact Laurel Lynch@ 817-257-5794 or


DVD copies – We have had an abnormally high request for additional copies of DVDs.  Please indicate to us BEFORE we begin your studies if you want separate DVDs for multiple patients.  If we do not get confirmation of this before we start, all studies (at one location) will be put on one single DVD and the facility can make additional copies.  If the request for additional copies is made later, there will be charge of $10.00 for a copy of the DVD and postage. Due to the amount of formatting time etc., that it takes to copy a DVD, we will not be able to make additional copies while we are there.


FDA approval for medical device to assist swallowing   – Press Release

Ampcare, a TECH Fort Worth Acceleration Client and winner of 2012 Heath Impact Award, has received U.S. Food and Drug Administration (FDA) clearance to market its Rx3E series of electrodes that apply external stimulation to the muscles necessary for swallowing.  The electrode device is used in conjunction with exercises to assists those that have lost the ability to protect their airway when eating and drinking, most notably those suffering from strokes and progressive neurological diseases, including Parkinson’s, Alzheimer’s, ALS (Lou Gehrig’s Disease) and Muscular Dystrophy.  Ampcare was founded in 2007 by Russ Campbell, President and CEO; Rick McAdoo, Vice President-Sales and Ronda Polansky, Vice President- Marketing.  The three therapists envisioned the device as a treatment option to contribute to better practices to treat swallowing problems in 1995 while working in an in-patient rehabilitation facility. Ampcare has patented the methodology of rehabilitation for the musculature involved in swallowing and the specification of design for the electrode device. An end user would buy Ampcare’s electrodes and the posture device and perform this protocol with any FDA-cleared, powered muscle stimulator. The FDA 510K clearance to market is an approval process that establishes the electrode device as equivalent in “safety and effectiveness” to other already marketed devices. This device will be used by application of external electrical stimulation to the muscles whose primary functions are to provide airway protection during the act of swallowing. Traditional electrodes are round; Ampcare’s are pie-shaped and larger, allowing for greater electrical dispersion and less resistance to current. It is manufactured by Tyco/Uni-Patch, a subsidiary of Covidien. The electrode device can be purchased at Restorative Medical, Inc., and eventually at the Ampcare website,  Russ Campbell will present supporting research data from Sheffield University, U.K. at the European Society for Swallowing Disorders in Barcelona, Spain October 25-27 and to Hemax Health in Hong Kong, China on December 9. Ampcare’s first eight-hour hour American Speech and Hearing Association (ASHA) continuing education course for 2013 is scheduled for April 20th in Arlington, Texas

More information about Ampcare can be found at